0 Multivitamins with minerals may protect older women with invasive breast cancer

Findings from a study involving thousands of postmenopausal women suggest that women who develop invasive breast cancer may benefit from taking supplements containing both multivitamins and minerals. The new research, published today in Breast Cancer Research and Treatment, found that the risk of dying from invasive breast cancer was 30 percent lower among multivitamin/mineral users compared with nonusers.

"Our study offers tentative but intriguing evidence that multivitamin/mineral supplements may help older women who develop invasive breast cancer survive their disease," said Sylvia Wassertheil-Smoller, Ph.D., lead author of the study and distinguished university professor emerita of epidemiology and population health at Albert Einstein College of Medicine of Yeshiva University.

Multivitamin/mineral supplements are the most commonly consumed dietary supplements among U.S. adults. They usually contain 20-30 vitamins and minerals, often at levels of 100 percent of U.S. Recommended Dietary Allowances or less, and the usual label recommendation is to take them daily.

The research was conducted as part of the Womens Health Initiative Clinical Trials and the Womens Health Initiative (WHI) Observational Study. Combined, the two studies include data from 161,608 postmenopausal women ages 50 to 79 when they first joined the study. These women were enrolled at 40 clinical centers throughout the United States during the years 1993-1998.

The current study focused on 7,728 participants who were diagnosed with invasive breast cancer during the WHI and were followed for an average of seven years after their diagnosis. Invasive breast cancer is defined as cancer that has spread outside the membrane of the milk glands or ducts and into the breast tissue. Two common types of invasive breast cancer are invasive ductal carcinoma and infiltrating lobular carcinoma.

After enrolling in the WHI and during repeated follow-up visits, all participants provided extensive information about their health including whether or not they had taken a multivitamin/mineral supplement at least once a week during the prior two weeks.

About 38percent of the 7,728 women who developed invasive breast cancer during the WHI were using the supplements. The vast majority were taking the supplements before their breast-cancer diagnosis. A comparison of mortality rates revealed that women with invasive breast cancer who took multivitamin/mineral supplements were 30 percent less likely to die from their cancers than women with invasive breast cancer who hadnt taken the supplements.

Could differences between the multivitamin/mineral users and nonusers account for this finding? The researchers looked at many possible confounding factors including additional supplements that the women took, their smoking status, education, race/ethnicity, weight, depression, alcohol use, physical activity, age at breast cancer diagnosis, and diabetes. The association between regular use of multivitamin/mineral supplements and reduced risk of death persisted even after these factors were taken into account.

"Controlling for these other factors strengthens our confidence that the association we observed – between taking multivitamin/mineral supplements and lowering breast-cancer mortality risk among postmenopausal women with invasive breast cancer – is a real one," said Dr. Wassertheil-Smoller, who also holds the Dorothy and William Manealoff Foundation and Molly Rosen Chair in Social Medicine Emerita. "But further studies are needed to confirm whether there truly is a cause-and-effect relationship here. And our findings certainly cannot be generalized to premenopausal women diagnosed with invasive cancer or to other populations of women."

0 Excessive testosterone raises mortality risk in older men

Chevy Chase, MD—Older men whose testosterone levels were neither low nor high tended to live longer, according to new research accepted for publication in The Endocrine Societys Journal of Clinical Endocrinology & Metabolism.

Testosterone is a key male sex hormone involved in maintaining sex drive, sperm production and bone health. Physicians have long known that low testosterone levels can signal health problems, but the new study found men may not fare better when levels of the hormone rise too high.

"Older men who had testosterone in the middle range survived longer than their counterparts who had either low or high levels of the hormone," said the studys lead author, Bu Beng Yeap, MBBS, FRACP, PhD, of the University of Western Australia, based in Fremantle Hospital, Western Australia. "When the body metabolizes testosterone, it produces dihydrotestosterone (DHT), which is tied to a lower risk of dying from ischemic heart disease. Having the right amount of testosterone and higher levels of DHT might indicate these men are in better health overall, or it could help them maintain good health as they grow older."

The population-based cohort study analyzed the mortality rate in a group of 3,690 community-dwelling men between the ages of 70 to 89 in Perth, Western Australia. Participants testosterone and DHT levels were measured between 2001 and 2004. Researchers analyzed the groups survival rate as of December 2010.

Researchers divided the men into four groups based on their testosterone levels. Men with the lowest testosterone levels had the highest cumulative mortality rate, followed by the men with the highest testosterone levels. Men with circulating testosterone levels in the 9.8 to 15.8 nmol/L range tended to live longer.

"Sex hormones are an important predictor of mortality in older men, but we havent determined if treatments to change testosterone and DHT levels can alter these outcomes," Yeap said. "Additional research into these findings, including randomized clinical trials, could help identify ways to leverage this information to improve health in older men."

0 No evidence drugs vitamins supplements help prevent cognitive decline in healthy older adults

A review of published research has found no evidence that drugs, herbal products or vitamin supplements help prevent cognitive decline in healthy older adults.

The review, conducted at St. Michaels Hospital, found some evidence that mental exercises, such as computerized memory training programs, might help.

"This review provides some evidence to help clinicians and their patients address what strategies might prevent cognitive decline," said Dr. Raza Naqvi, a University of Toronto resident and lead author of the review.

The issue is of particular importance given that mild cognitive impairment affects 10 to 25 per cent of people over age 70. Mild cognitive impairment is characterized by reduced memory, judgment, and decision-making skills compared to someone of a similar age, but not enough to interfere with daily activities.

The annual rate of decline into dementia, such as Alzheimers disease, is about 10 per cent. Given that rate and the aging population, its estimated the number of Canadians with dementia will double to more than 1 million in the next 25 years.

Researchers including Dr. Sharon Straus, head of the Knowledge Translation Program at St. Michaels, reviewed 32 randomized clinical trials involving about 25,000 patients.

They found no strong evidence for pharmacologic treatments such as cholinesterase inhibitors that were developed to improve the effectiveness of acetylcholine, a chemical messenger that assists memory, thought and judgment.

Nor was there strong evidence that herbal supplements such as gingko improved cognitive functions or vitamins and fatty acids such as vitamin B6 or omega-3 fatty acids.

Some studies on estrogen actually indicated an increase in cognitive decline and dementia.

Evidence on the value of physical exercise, such as strength-training, was weak.

The strongest evidence was for the value of mental exercises such as computerized training programs or intensive one-on-one personal cognitive training in memory, reasoning, or speed of processing.

Dr. Naqvi said future studies should address the impact of cognitive training on the prevention of cognitive decline.

"We encourage researchers to consider easily accessible tools such as crossword puzzles and sudoko that have not been rigorously studied," he said. "The studies in this review that assessed cognitive exercises used exercises that were both labour- and resource-intensive, and thus may not be applicable to most of our patients."